阴沟肠杆菌对碳青霉烯类药物的耐药机制  被引量:6

Antimicrobial resistance mechanism of Enterobacter cloacae to carbapenems

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作  者:刘丽娟 王学 姜梅杰[3] 赵书平[3] 任玉国 LIU Li-juan;WANG Xue;JIANG Mei-jie;ZHAO Shu-ping;REN Yu-guo(Department of Laboratory Medicine,Jinan City People’s Hospital,Jinan 271100,China;Department of Laboratory Medicine,People’s Hospital of West Coast New District of Qingdao Huangdao District,Qingdao 266500,China;Department of Laboratory Medicine,Taian City Central Hospital,Taian 271000,China)

机构地区:[1]济南市人民医院检验科,山东济南271100 [2]青岛市黄岛区西海岸新区人民医院检验科,山东青岛266500 [3]泰安市中心医院检验科,山东泰安271000

出  处:《中国感染控制杂志》2021年第8期681-687,共7页Chinese Journal of Infection Control

基  金:山东省自然科学基金(ZR2016HL44)。

摘  要:目的研究耐碳青霉烯类阴沟肠杆菌分子流行病学特征和碳青霉烯耐药机制,为临床经验性用药及医院感染防控提供依据。方法对某院2019年4—9月分离的耐碳青霉烯类阴沟肠杆菌进行菌种鉴定及药敏分析,mCIM联合eCIM试验筛选碳青霉烯酶,聚合酶链反应(PCR)方法检测碳青霉烯酶耐药基因,多位点序列分型(MLST)和脉冲场凝胶电泳(PFGE)进行分子流行病学特征分析。结果8株耐碳青霉烯类阴沟肠杆菌中5株来自于重症监护病房(ICU),对临床常用头孢类及加酶抑制剂药物均表现出高水平耐药的特性。所有菌株均携带金属β-内酰胺酶,7株为bla NDM-1,1株为bla IPM-4。MLST分子分型及PFGE同源性分析有6个ST序列类型,6个克隆群。ST596(3株)均为A群、ST121(1株)为C群、ST993(1株)为F群、ST91(1株)为E群、ST794(1株)为B群、ST88(1株)为D群。结论该院耐碳青霉烯类阴沟肠杆菌主要来源于ICU,产金属酶bla NDM-1β-内酰胺酶是其主要耐药机制。ST596 A群阴沟肠杆菌短时间内在ICU存在局部流行,应加强医院感染防控措施,遏制暴发流行。Objective To study the molecular epidemiological characteristics of carbapenem-resistant Enterobacter cloacae(CREC)and mechanism of carbapenem resistance,provide basis for clinical empirical antimicrobial use as well as prevention and control of healthcare-associated infection.Methods CREC isolated from a hospital between April and September 2019 were identified and performed antimicrobial susceptibility analysis,carbapenemase was screened by modified carbapenem inactivation method(mCIM)and EDTA-modified carbapenem inactivation method(eCIM),carbapenem-resistant genes were detected by polymerase chain reaction(PCR),molecular epidemiological characteristics were analyzed by multilocus sequence typing(MLST)and pulsed-field gel electrophoresis(PFGE).Results Among 8 strains of CREC,5 were from intensive care unit(ICU)and were highly resistant to cephalosporins and enzyme inhibitors commonly used in clinical practice.All strains carried metallo-β-lactamases,7 strains carried bla NDM-1 and 1 strain carried bla IPM-4.MLST molecular typing and PFGE homology analysis showed 6 ST sequence types and 6 clone groups.ST596(3 strains),ST121(1 strain),ST993(1 strain),ST91(1 strain),ST794(1 strain)B and ST88(1 strain)belonged to groups A,C,F,E,B and D respectively.Conclusion CREC in this hospital mainly comes from ICU,producing of metalloenzyme bla NDM-1β-lactamase is the main resistance mechanism.ST596 group A Enterobacter cloacae has local epidemic in ICU for a short time,prevention and control measures of HAI should be strengthened to curb the outbreak.

关 键 词:阴沟肠杆菌 碳青霉烯耐药阴沟肠杆菌 耐药性 碳青霉烯酶 多位点序列分型 

分 类 号:R181.32[医药卫生—流行病学]

 

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